Boy Scout Troop 212
Chapel Hill Presbyterian Church
Troop Outing Permission Slip

I, the parent or guardian of _____________________________________________________
hereby give my consent and permission to participate in the:

__CANOEING AT KOPACHUCK STATE PARK__ Outing

From (Departure Date)__May 19, 2007__To (Return Date)__May 20, 2007__

I do hereby waive, release, absolve, indemnify, and agree to hold harmless any person connected with Chapel Hill Presbyterian Church, Troop212, the scouting program, and persons transporting my child

I am willing to provide transportation  ________  Number of people including driver _______

My son will be arriving late / leaving early ________  If yes, please provide details below

_____________________________________________________________________________

My son has a medical condition (i.e. allergies, etc.) and / or is taking medication __________
If yes, please provide details below.  Please contact the adult in charge with written Instructions.

 _____________________________________________________________________________

_____________________________________________________________________________

Emergency contact if you are unavailable

Name_____________________________________________

Phone ____________________________________________

Signed_____________________________________Phone_______________Date___________

_____________________________________________________________________________
detach here

Retain this portion until the outing is complete

Outing Name __Canoeing at Kopachuck State Park__

Meet at QM Container____7:00 am  Saturday May 19, 2007___________________

Return to QM Container __ 1:00  pm Sunday May 20. 2007__________________

Adult in charge __Mr. Schlaudruff______________ Phone__253-857-6831______

Emergency contact:  Gretchen McKinney            Phone    235-549-2959

Scouts: Wear your scout shirt during travel.  Dress for wet weather. You need a daypack and ten essentials.